According to the National Action Plan for Cancer Survivorship, culturally competent patient education and care is a priority (2015). The Cancer Outreach Project at MD Anderson Cancer Center Cooper provides culturally and linguistically appropriate cancer education and screening to underserved Asian-Indio women through the use of a dedicated outreach worker and Nurse Practitioner run clinic. A collaborative relationship was established in 2007 between the Cancer Outreach Project and National Indio Cooperative Enterprises, Inc. (NICE), a non-profit organization dedicated to service of the Indian community in Southern New Jersey, U.S. The Cancer Outreach Project provides health promotion and disease prevention activities that specifically focus on cancer education and screening to women rarely or never before seen for women’s healthcare due to their culturally diverse health beliefs and practices. Specifically, within the Asian-Indio popualtion, these beliefs and practices have been influenced by both the Ayurveda medical system and the Hindu religion (Gordon, Bernadett, Evans, Sharpiro and Patel, 2016).
In order to reach women that were not geting screened for cancer, a dedicated clinic within a suburban medical oncology out-patient setting was established. A Nurse Practitoner (NP) and Outreach Worker/Lay Navigator have worked in tandem one day a month in the clinc setting providing screening and follow-up over a 9 year time frame to Asian-Indio women Clinical breast examination (CBE), screening and or diagnostic mammography based on the result of the CBE, Pap smear and pelvic exam, immunochemical fecal occult blood testing and referral for colonoscopy as per American Cancer Society (ACS) guidelines related to patient age and risk factors are provided (ACS, 2016). Those with abnormal findings were referred for diagnostic services at no cost through grants from the New Jersey Cancer Early Education and Diagnosis Program (NJCEED) or Susan G. Komen for the Cure. The Program also made referrals to the New Jersey Charity Care Program, MD Anderson at Coopers' Comprehensive Breast Center, Cooper's Women’s Care Center and/or Department of Gastroenterology.
Methods: IRB approval was obtained to conduct a retrospective chart reviewso that outcome of the program could be complied and reviewed. Data analysis consisted of descriptive statistics and regression analysis.
Results: From its inception in 2007 through June 30, 2016, slightly over 750 Indian women with a mean age of 47.5 years have been educated through the programs outreach activities at Temples and through home health parties (Byrne & Robles-Rodriquez, 2009) provided by a dedicated Outreach Worker/Lay Navigator with close ties to the community. Approximately one-third of this population (n= 249) with a median age of 53 years has participated in both initial and continued cancer screening clinics. Outcomes included six cancers have been diagnosed through the program; (1) DCIS, (1) LICS, (1) Stage I breast cancer, (1) Stage III breast cancer, (1) cervical cancer and (1) endometrial cancer. Further data will be discussed in detail .
Conclusion: Identification of facilitators and barriers related to participation in cancer screening within the Asian Indio female population has implications for practice. Strategies such as identification of and collaboration with key stakeholders in the Asian-Indio community, obtaining funding for a lay navigator and coordination of a dedicated clinic and culturally tailored program are noted to influence initial and on-going early detection behaviors. The sharing of lessons learned from this research may benefit other healthcare providers interested in developing sustainable cancer screening services for this select population.